Monthly Pain Update – January 2025

Glute Weakness and Low Back Pain

While we traditionally view low back pain as the result of a problem localized to the low back itself, several studies have found that issues in adjacent parts of the body can play a role in the development of low back pain.  For example, chronically tight hamstrings can affect pelvic tilt, which in turn can alter the posture of the lumbar spine, potentially leading to low back pain. Another potential contributor to low back pain that’s often overlooked is glute muscle weakness.

In September 2024, the New York Times ran an article focused on a condition called gluteal amnesia, though it’s more colloquial name is dead butt syndrome. Gluteal amnesia is the result of prolonged inactivity of the three glute muscles (maximus, medius, and minimus). Prolonged inactivity can occur from things such as sitting at a desk or in a car for more than two to three hours at a time without getting up to move around and stretch. The gluteals help stabilize the hip, lift the leg, and rotate the thigh. This muscle group also serves an important role in the kinetic chain, and when not working properly, the risk for problems like hamstring tears, sciatica, shin splints, and knee arthritis increases.

Gluteal amnesia is NOT like the temporary numbness/tingling noticed when we sleep on an arm and it “falls asleep” or goes numb and recovers quickly when we change positions. Some people may feel a dull ache or pain after a long walk or after a jog or hike. Because muscle strength and activation are affected, the body may recruit nearby muscles to help perform regular movements, which can lead to pain in the lower back, for example.

Though it’s best to be examined by a qualified healthcare provider, like a doctor of chiropractic, you can perform the following test to check if you may have dead butt syndrome: stand on one leg letting the other leg dangle (standing sideways on a step holding onto a railing works well) press into your buttocks region on the dangling leg, it should feel soft (not firing); do the same on the other side; now stand on both feet and squeeze your “cheeks” hard; you should feel the muscle contract or get firm; if it takes a few squeezes before you feel it get firm, then you may have gluteal amnesia.

The key to overcoming this condition is to restore normal activation to the gluteal muscles. You can start by setting an alarm on your phone to stand up every 30-50 minutes and gently tap on your glut/butt cheeks with your fingertips. This reminds the brain that these muscles need to fire. Better yet, march in place, do some hip circles and squats and consciously tighten your gluts with each rep. Other exercises for this include clamshells, hip thrusts, side planks, split squats, and single-leg glut bridges. Just remember to consciously engage the glutes.

If the condition persists, schedule an appointment with your doctor of chiropractic so they can determine if there are additional problems present that can be addressed with treatments provided in the office, such as manipulative or mobilization therapy, with the goal of helping restore normal function.

Halting Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) occurs when the mobility of the median nerve is restricted as it passes through the wrist on its way to the hand. The condition typically comes on gradually and intermittently causing many sufferers to hold off on seeking care until the pain, numbness, tingling, and weakness becomes too much of a burden to carry out everyday activities. We often look at CTS after it’s developed, but is there anything that can be done early on to slow or halt the progression of the condition?

Past research has shown that CTS patients often experience weakening in their grip and pinch strength. In a 2024 study, researchers recruited 62 office workers with the early signs and symptoms of CTS and separated them into two groups. Forty-nine participants were assigned to an exercise group with the aim of improving hand strength, and thirteen did not receive any exercise instruction and served as the control group. The three-times a week for eight-week exercise protocol included:

• Median nerve mobilization: Raise one arm 90 degrees sideways, elbow straight, make a fist with the thumb pointing up, rotate the head to the opposite side and perform repetitive flexion and extension of the wrist. Repeat using the other arm.
• Stretching the median nerve: Raise BOTH arms to 90 degrees sideways, keeping the elbow, wrist, and fingers straight with palms facing down, looking straight ahead. Lengthen your arms as if to push two walls apart.
• Chest Stretch: Stand sideways to a wall, raise one arm 90 degrees sideways, elbow straight, place your palm on the wall-fingers pointing backward, slowly take a step forward and hold until the stretched chest muscles relax. Repeat using the other arm.
• Flexor Forearms stretch: Kneel on all fours, fingers pointing forwards/elbows straight, shift your weight forward until you feel a firm forearm stretch and hold.
• Wrist Curls (Flexors): Use a light weight, palm up, elbow next to your side bent at 90 degrees. Move the weight slowly up and release slowly down. Repeat using the other arm.
• Wrist Curls (Extensors): Same except the palm face down. Repeat using the other arm.
• Pronation/Supination resistance: Same as 5 and 6 but slowly rotate your hand/palm up and down (like an airplane propeller).

Assessments performed after the eight-week intervention revealed the exercise group experienced greater overall improvement in function, particularly grip and pinch strength. This led the authors to conclude that such an exercise protocol could help slow or even halt the progression of CTS in its earliest stages, especially when combined with other measures such as ergonomic improvements and more frequent breaks to allow the tissues passing through the wrist to recover.

Managing Femoroacetabular Impingement Syndrome

Musculoskeletal conditions, including hip-related pain, are a leading cause of pain and disability and represent the second-largest global contributor to years lived with disability. Among hip-related pain conditions, the most common is femoroacetabular impingement syndrome (FAI). In fact, femoroacetabular impingement syndrome affects up to 15% of young adults and is a leading cause of hip pain in active individuals. This condition occurs when the femoral head (the ball of the hip joint) makes abnormal contact with the acetabulum (the socket of the hip joint), potentially damaging the joint and leading to pain and a reduced ability to carry out daily activities.

As with most treatment guidelines, outside of major trauma that results in sudden loss of function, patients are generally encouraged to pursue conservative treatment options as a first-line course of care. This approach is recommended because surgery can have several drawbacks: it’s expensive, recovery periods can be lengthy, results may not always meet expectations, and there are inherent risks associated with surgery itself. In contrast, conservative treatment approaches tend to be more cost-effective, allow patients to continue performing daily tasks to the best of their ability, and enable healthcare providers to adjust the treatment plan as needed.

But how effective are non-surgical approaches? In 2020, researchers conducted a systematic review and meta-analysis of data from 14 studies and found that manual therapies, core stability exercises, and exercises designed to increase hip range of motion and strength were effective in improving hip pain and function—especially when used in combination. Furthermore, the research team reported that patients who underwent hip arthroscopy surgery did not report better outcomes than those who received conservative care at a 24-month follow-up. The authors concluded that patients with femoroacetabular impingement syndrome should follow treatment guidelines and exhaust non-surgical options before considering surgery.

When a patient seeks chiropractic care for suspected femoroacetabular impingement syndrome, the doctor of chiropractic will evaluate the patient holistically. This includes assessing potential issues outside the hip joint, as factors lower on the kinetic chain can place abnormal stress on the joint. For example, the chiropractor may examine for foot/ankle pronation, abnormal knee angles, leg length inequality, and other biomechanical issues. If such issues are present, addressing these factors is essential for achieving the best possible outcomes for the patient.

A Multi-Pronged Treatment Approach for Neck Pain

Non-specific mechanical neck pain is a common condition that affects up to 70% of the population at some point during their lifetime, and between 15-20% may have some degree neck pain at any given moment. The descriptor non-specific refers to the fact the condition arises from musculoskeletal strain or dysfunction in the neck region in the absence of a specific underlying medical pathology like degenerative disk disease, meningitis, rheumatoid arthritis, tumors, osteoporosis, and more. Because of the musculoskeletal nature of non-specific mechanical neck pain, patients often seek out chiropractic care; in fact, neck pain is the second most common reason people visit a chiropractor. When managing the condition, chiropractors will often use a combination of treatments, with manual therapies and stabilization exercises providing an excellent option.

In patients with neck pain, it’s common for the deep muscles that stabilize the spine to reduce their activity in an effort to protect injured tissues from further injury. When this happens, the superficial muscles pull double duty to both stabilize the spine and carry out our brain’s directions to move the body around. This overactivity leads to fatigue, which can increase the risk for further pain and disability in the neck, as well as altered biomechanics elsewhere, potentially causing musculoskeletal pain in other parts of the body. The goal of spinal stabilization exercises is to activate the deep muscles and decrease overactivity of the superficial muscles. These exercises may initially be performed in-office under supervision to ensure they’re performed correctly but over time, patients should be able to engage in such exercises between visits.

Manual therapies like manipulation, mobilization, trigger point, and myofascial release applied to the joints, muscles, and/or other soft tissues can help modulate pain signals, restore normal joint movement, increase nerve mobility, correct misalignments, enhance blood flow, relax muscles, restore range of motion, and enhance proprioception or balance. The specific manual therapies and where they are applied will depend on the patient’s history, exam findings, patient preference, and their chiropractor’s training and clinical experience. Treatment may include more than one manual therapy, as well.

While manual therapies and stabilization exercises on their own have both been demonstrated to improve nonspecific mechanical neck pain and disability, studies have shown that patients experience greater outcomes (and potentially speedier results) when these treatment options are combined.

The Whiplash Chiropractic Patient Experience

Whiplash-associated disorders (WAD) is the term that properly describes the injuries sustained as a result of the sudden acceleration-deceleration of the head and neck, most commonly during a motor vehicle collision. In many instances, patients seek out chiropractic care to address the myriad symptoms linked to WAD such as pain, stiffness, muscle spasm, headache, cognitive fog/concussion, dizziness, and more, especially when they’re unable to carry out their normal activities of daily living. So, what can a patient expect when they present for care?

First, the patient will complete paperwork to provide a detailed history of the collision or mechanism of injury followed by a list of questions for each complaint such as onset after impact, factors that increase and decrease pain, the quality of pain, location/radiation of symptoms, grading the severity (pain now, on average, at best, at worst), timing of the symptoms (worse in the morning vs. night), and importantly past history of neck pain and/or injury. When headaches are present, extra historical information is important: location, duration, intensity, quality, factors that increase or decrease headache pain, past and family headache history, and more.

The next step is a thorough examination of the neck, back, extremities, nervous system, and posture that will include observation, palpation, orthopedic provocative tests, neurological tests, and often, x-ray to assess cervical spine posture, rule out fracture, and more. Stress x-rays bending the head forward, backward, and sideways may also be taken. If balance impairment or dizziness is present, an examination of eye movements may be conducted. If special tests are needed, most chiropractors have a network of allied healthcare professionals to consult with, co-manage, and/or to refer patients.

This information will then be used to determine all potential pain generators (injured tissues) so that a treatment plan can be devised. The initial approach following injury (the acute stage) is to educate the patient, encourage resumption of normal activity within pain tolerances, reduce inflammation (ice on/off/on/off/on) or contrast (ice/heat/ice/heat/ice), and exercises and manual therapies to help restore normal motion. To augment in-office care, they may also employ physiotherapy modalities such as ultrasound, electric stim, laser, pulsed magnetic field, etc.

Your doctor of chiropractic will perform re-examinations on a periodic basis to assess progress. If the condition isn’t responding to care as expected, they may modify their approach or refer you to an allied healthcare provider for services not typically offered in a chiropractic setting.

Manual Therapy and Parkinson’s Disease

The term gait refers to the human steady state of walking. Although most of us don’t have to concentrate on walking from one room to another, this task is actually very complex for our balance control system as it requires the integration of multiple sensory input arising from the somatosensory, vestibular, and visual systems. It also necessitates the coordination of multiple skeletal muscles and involves executive (brain-driven) functions. Because of this, individuals with sensory, motor, and/or cognitive deficits—like patients with Parkinson’s disease—may develop a gait disorder.

Parkinson’s Disease is a common progressive neurodegenerative condition characterized by various motor and non-motor symptoms that impact a patient’s quality of life. The primary clinical signs of the disease include a resting tremor, bradykinesia (moving slowly), rigidity and postural instability. Secondary motor symptoms include a flexed or bent-forward posture and freezing of gait. As motor dysfunction progresses, this often leads to difficulties in coping with daily locomotor tasks such as gait initiation, walking, obstacle crossing, and/or moving around a more confined space like a home—which can increase the risk for serious fall and injury.

When we think of manual therapies provided by doctors of chiropractic, we often do so from a pain relief perspective. However, manual therapies also stimulate several biomechanical, neurophysiological and psychological changes that result in improved motor control. For example, several studies have shown that manual therapies can have short-term positive effects on athletic performance. Until recently, few researchers have come at this from the opposite direction to see if patients with motor impairments can benefit from manual therapies.

In a systematic review published in January 2024, researchers looked at findings from three studies on the application of manual therapies in patients with Parkinson’s disease. They found that mobilization and manipulative therapies applied to the cervical, thoracic, and lumbar spine, shoulder girdle, sacroiliac joint, hip bones, leg musculature, and ankles may result in significant improvements in dynamic gait tasks like walking on a level surface, changing gait speed, turning the head in a horizontal and vertical direction while walking, rapid directional changes, stepping over and around an obstacle, and stair climbing.  However, due to the limited research on the topic, the authors of the review were unable to draw firm conclusions and noted that further research is needed to explore the topic.

Because the number of Parkinson’s cases is expected to double in the next two decades, it’s a certainty there will be an increased need for therapies to help patients maintain their independence. It seems likely that chiropractors may eventually find themselves as valuable partners in managing patients with Parkinson’s disease.

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.